Lee Came to the US from the UK looking to try BalanceWear. He had been deteriorating quite a bit the past few months and had great difficulty walking and has balance and mobility issues.

Multiple System Atrophy (MSA) is a rare, incurable disease whose cause is unknown. It currently affects up to .02% of the US population, equally likely to occur in men and women across all ethnic groups. The disease tends to cause initial symptoms in the patient’s 50s, and then rapidly worsens over the course of five to ten years – the patient usually needs the support of an assistive device such as a cane or a walker after only a few years. The earliest symptoms of MSA are similar to the earliest symptoms of Parkinson’s disease; both often begin with slowness of movement, tremor, stiffness, incoordination, and impaired speech. Consequently, it is often difficult to distinguish MSA from Parkinson’s in its early stages. However, unlike Parkinson’s, whose movement-limiting symptoms are caused by the death of nerve cells in a specific, small region of the brain called the substantia nigra, the symptoms of MSA can reflect the death of multiple types of nerve cells in the brain and the spinal cord. Because of the variability in the types of cells that be affected within the MSA diagnosis, a patient’s symptoms generally are classified into one of two types: the parkinsonian type, with characteristics similar to Parkinson’s disease, and the cerebellar type, with characteristics including ataxia and loss of coordination. What both types have in common is a debilitating loss of mobility. Because there is no known cure for the underlying neurodegeneration of MSA, the focus of therapeutic care is on the improvement of the patient’s quality of life by slowing the loss of mobility.

Looks like Lee has new training wheels for the Holidays. We are wishing him the best of luck in his rehabilitation.

Hip strength is integral to improving balance during standing or walking activities. Below are exercises to strengthen the hips in two directions: abduction and adduction.
Abduction involves moving the leg outward, away from midline of the body.
Adduction involves moving the leg inward, toward midline of the body.

Basic (Snow Angels)
1. Lay on back with arms at rest on chest or abdomen and head supported with a pillow
2. Perform “snow angel” movement: Move right leg slowly and smoothly away from and then back toward the left leg while keeping legs in full contact with the surface.
3. Perform 3 sets of 10-20 repetitions or until fatigued
4. Repeat on left leg.
5. MODIFICATION: if this exercise is too difficult to perform due to friction of the moving leg on the sliding surface, place a plastic bag under the heel of the moving leg to reduce friction.
Muscles used: inner thigh and outer hip muscles

Intermediate (Clam shells for abduction)
1. Lay on side on a firm surface (floor or firm bed) with knees bent to 90 degrees.
2. Keeping your feet touching, hinge open your top leg about 12 inches without letting your hips fall forward or backward. Your knees will open up like a clam shell does (hence the exercise name).
3. Hold for 1-3 seconds and perform 10-20 repetitions or until fatigued.
4. Lay on other side and repeat
Muscles used: outer hip muscles

Intermediate (Pillow squeezes for adduction)
1. Sit upright on firm surface (chair, bench, etc.) with good posture and feet flat on floor with knees bent to 90 degrees.
2. Place pillow between knees and squeeze that pillow for 3-5 seconds and repeat 10-20 times or until fatigued.
Muscles used: inner thigh muscles

Multiple system atrophy, MSA, is a disease affecting many parts of your body. Much like Parkinson’s disease or cerebellar disease depending on the sub type representing most symptoms.
Symptoms closely related to Parkinson’s are tremor, slow movement, rigidity, and impaired balance and posture. While the cerebellar type is associated with loss of coordination, slurred, slow and or soft voice, difficulty with swallowing, visual disturbances; such a blurred vision or problems focusing. A prominent sign is postural hypotension which involves low blood pressure resulting in dizziness or lightheadedness when changing position from lying or sitting. In some cases there can be a rise in blood pressure when going to a lying position. Patient may also have difficulty controlling their emotions. There are many other symptoms one might experience with MSA.

This blog will discuss treatments with patients on opposite sides of the country.

The first one is today. I recently had the chance to see two individuals with MSA; one in North Carolina and the other in Calaifornia. Both individuals were in their 50’s and had professional careers but were retired due to their illness. Lucky for them they both had wonderful supportive spouses. They were at different stages of MSA.

One gentleman was wheelchair bound, required maximal transfers and could not stand or walk anymore. His wife reported that he was hardly able to read due to blurred and double vision and runs into things with the electric wheelchair. I wasn’t the treating therapist as we had several patients in the treatment room while I was teaching. I did help with his treatment however. He was a rather large individual. In the wheelchair during pretest he was unable to maneuver around cones without running over them. He had emotional outbursts of uncontrollable laughing while driving the electric wheelchair, testing his vision and especially during perturbations (Nudges to see where you fall off balance). His vision was positive for nystagmus (jerkiness of the eyes) and decreased convergence (decreased ability to bring eyes close to center when an object is getting closer to your nose). He held his eyes almost closed like slits. It was maximal effort to transfer him from electric wheelchair to the mat. He could sit with slight posterior loss of balance requiring him to hold his arms closely in front of him. He exhibited uncontrolled laugh.

After testing we placed the weights on him. This actually took the most weight I have ever used, five pounds strategically placed. We got him standing with stand by assist. His wife transferred him with minimal assist. His eyes opened more and were no longer slits. His uncontrolled laughing ceased and he looked relaxed. We repeated the vision tests and they showed some improvement. When we repeated the driving in the electric wheelchair he did not hit the cones. In addition his trunk and arms became relaxed. He watched the next treatment and did not have any outbursts of laughing. Can some of the outburts be associated with uneasiness? Hmm???

His wife stated that giving patients a little more ability is so gratifying to them. To the spouse also. This treatment was going to have the potential to decrease her work in tranfering him from the wheelchair to the chair or other surfaces. This was a double win for this family. Also improving the ability to steer his wheelchair will make everything safer.

I have not worked with many people who have been wheelchair bound but this treatment gives me hope that we can help make a difference for them with BalanceWear!

This video depicts the emotions of being in the hospital of both caregivers and patients. Everyone has something going on in their head at all times. Many times we don’t take the time to understand how the person feels, their wants, or their needs. We put our own thoughts into the equation about what we think they need as health care professional.

I saw an email come by the other day of a woman crying as she saw a video of a person able to dance at the National Ataxia Foundation…she wrote she is afraid to leave the house because she knows people think she is drunk…but she has ataxia. One of the doctors I showed the same video to said, “She said she had ataxia..right? But you don’t know…” In other words he felt she was magnifying her symptoms or she had a psychological problem. Why would someone be at the National Ataxia Foundation Meeting???

When I mentioned this to the person in the video ( the person who could dance for the first time in 12 years) she said the first few years they sent me to a psychologist. Really!!! Why can’t we just try to help people instead of making judgements.

What I can’t understand is why we wouldn’t want to understand why she can dance rather than think she is having symptoms of ataxia for alternative purposes.

I will continue this discussion… Please try to understand and not make judgements:)

Exercise class

Exercise class

Causes of Balance and Mobility Impairment in Multiple Sclerosis

Multiple sclerosis is a progressive autoimmune disease typically diagnosed in young adults, affecting the central nervous system causing damage to the myelin surrounding the nerves and lesions in the brain. Although the disease progresses differently in each person often gait and mobility problems are encountered. Individuals experience many different symptoms such as loss of sensation, visual or vestibular function, spasticity, weakness, central processing and motor output dysfunction. Any or all of the symptoms may contribute to a loss of balance leading to difficulty in walking.
If you experience balance problems you should see a physical therapist who is knowledgeable in treating patients with multiple sclerosis. Many people in my MS exercise class partially funded by the MSFoundation find they are able to do so much more than they thought they were capable of. When people get the diagnosis that they have a neurodegenerative disease and experience a relapse many do not rehabilitate back to where they started. With proper guidance many of them are experiencing recovery of function that they thought was unattainable.